Assessment of the ocular fundus, traditionally by direct ophthalmoscopy (DO), is essential to evaluate many neurologic diseases. However, the status of DO training in neurology residencies is ...unknown. We conducted a needs assessment to determine current attitudes, curricula, and gaps in DO training.
A survey was developed and administered to residents and program directors (PDs) at ACGME accredited neurology residencies in the United States. The survey assessed factors such as current DO curricula, perceived importance of DO, confidence of skills, and need for improvement. Data analysis was performed using the Mann Whitney U test and Fisher Exact Test.
Nineteen PDs (11.6%) and 74 (41.1%) residents responded to the survey. 97.1% of residents and 100.0% of PDs believe DO is an important skill to learn. 29.4% of PDs expected graduating residents to have completed > 10 supervised DO exams, while 0.0% of graduating fourth year residents reported doing so (p = 0.03). 35.7% of graduating residents had never correctly identified an abnormal finding on DO. The number of times residents practiced DO unsupervised correlated with increasing confidence in all components of the DO exam (p < 0.05). Residents who felt their program emphasized DO were more likely to perform DO at least once a week compared to residents who did not perceive program emphasis (61.9% vs. 35.0%, p = 0.02) and were more confident in DO (p < 0.05). 66.7% of residents and 42.1% of PDs were not satisfied with current levels of DO training. 96.7% of residents and 78.9% of PDs felt it was important to improve curriculum for DO training. Supervised practice and practice skills sessions were identified as the most helpful interventions to improve DO training.
The vast majority of neurology PDs and residents believe DO is an important skill to learn, are unsatisfied with the current level of DO training, and advocate for improvement in DO curricula. Current DO curricula have limited formal didactic training and supervised practice. The bulk of DO learning occurs through unsupervised practice, which is influenced by motivational factors such as perceived residency emphasis on DO learning.
Metformin use has been associated with a decreased risk of age-related macular degeneration (AMD) progression in observational studies. We aimed to evaluate the efficacy of oral metformin for slowing ...geographic atrophy (GA) progression.
Parallel-group, multicenter, randomized phase II clinical trial.
Participants aged ≥ 55 years without diabetes who had GA from atrophic AMD in ≥ 1 eye.
We enrolled participants across 12 clinical centers and randomized participants in a 1:1 ratio to receive oral metformin (2000 mg daily) or observation for 18 months. Fundus autofluorescence imaging was obtained at baseline and every 6 months.
The primary efficacy endpoint was the annualized enlargement rate of the square root-transformed GA area. Secondary endpoints included best-corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) at each visit.
Of 66 enrolled participants, 34 (57 eyes) were randomized to the observation group and 32 (53 eyes) were randomized to the treatment group. The median follow-up duration was 13.9 and 12.6 months in the observation and metformin groups, respectively. The mean ± standard error annualized enlargement rate of square root transformed GA area was 0.35 ± 0.04 mm/year in the observation group and 0.42 ± 0.04 mm/year in the treatment group (risk difference = 0.07 mm/year, 95% confidence interval = -0.05 to 0.18 mm/year;
= 0.26). The mean ± standard error decline in BCVA was 4.8 ± 1.7 letters/year in the observation group and 3.4 ± 1.1 letters/year in the treatment group (
= 0.56). The mean ± standard error decline in LLVA was 7.3 ± 2.5 letters/year in the observation group and 0.8 ± 2.2 letters/year in the treatment group (
= 0.06). Fourteen participants in the metformin group experienced nonserious adverse events related to metformin, with gastrointestinal side effects as the most common. No serious adverse events were attributed to metformin.
The results of this trial as conducted do not support oral metformin having effects on reducing the progression of GA. Additional placebo-controlled trials are needed to explore the role of metformin for AMD, especially for earlier stages of the disease.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
GEOGRAPHIC ATROPHY Researchers find gray GA lesions had the highest cross-modality differences Fundus autofluorescence, a common imaging modality used to assess the retina, may be underreporting the ...sizes of geographic atrophy across various phenotyp-ic features, according to Noor Chahal, BS, who reported these findings at the 2023 Association for Research in Vision and Ophthalmology Annual Meeting. Images were then stratified based on the GA focality, homogeneity, size, and color to identify any significant differences in measurements between the semiautomatically graded fundus autofluorescence images and the other methods. ...they encourage clinicians and researchers to use a single, consistent modality for disease monitoring and progression and to consider GA phenotype when interpreting imaging results.
To investigate sex-based differences in inflammation-related biomarkers on spectral domain OCT.
Cross-sectional study.
Patients with diabetic macular edema (DME) between February 1, 2019, and March ...31, 2023, without intravitreal anti-VEGF injection within the prior 6 months.
We reviewed each patient’s medical record for age, biological sex, race and ethnicity, most recent glycated hemoglobin A1c (HbA1c) level, visual acuity (VA), and central macular thickness (CMT). OCT biomarkers that have been found in literature to be associated with inflammation, including disorganization of retinal inner layers (DRIL), retinal hyperreflective foci (HRFs), hyperreflective choroidal foci (HCFs), subfoveal neuroretinal detachment (SND), and perturbation in retinal nerve fiber layer thickness, ganglion cell layer thickness, and inner nuclear layer (INL) thickness were evaluated by graders masked to the clinical characteristics of the patients. We performed multivariable regression analyses with the OCT biomarkers as the outcome variables and sex, age, HbA1c, and CMT as independent variables.
OCT inflammation-related biomarkers as listed above.
Female patients were on average 2 years older than male patients (P = 0.041). There were no significant differences in race and ethnicity, HbA1c, VA, or CMT between male and female patients. After controlling for age, HbA1c, and CMT, we found male sex to be associated with more HRF (incidence rate ratio IRR = 1.19, 95% confidence interval CI = 1.10–1.29), more HCF (odds ratio = 2.01, 95% CI = 1.12–3.64), and thicker INL (7 μm thicker in males, 95% CI = 2–12). Sex was not a significant predictor for either DRIL or SND in the multivariable regression models. Patients with higher HbA1c were more likely to have more HRF (IRR = 1.02 per 1 point increase, 95% CI = 1.00–1.04) after controlling for other factors.
Male sex was correlated with more inflammation-related biomarkers on OCT including more HRF, more HCF, and thicker INL, after accounting for age, glycemic control, and amount of DME. Further studies are needed to evaluate the potential implications of these sex-based differences for individualized treatment.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
The influence of thermal effects on the reliability of RF MEMS switches is investigated in this paper. Low power consumption and capacity to handle high power at very high frequency elevate the scope ...of RF MEMS in the field of satellite and mobile communication technology immensely. The reliability of these switches are still under consideration as they fail due to thermal stresses developed during operation. A significant temperature rise occurs while transmitting high power at high frequency. In this paper, we introduced design parameters and investigated their influence to improve the switch's resistance to acute thermal stresses. A three dimensional finite element model of RF MEMS switch was simulated. A current density model and a thermal model were coupled to calculate the current density, heat loss and temperature rise within the domain. The maximum frequency and power range that the switch can handle before buckling failure were estimated.
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